Provider Demographics
NPI:1124161385
Name:PETERSON, BRENT ALLEN (BS, BC-HIS)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:ALLEN
Last Name:PETERSON
Suffix:
Gender:M
Credentials:BS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3807
Mailing Address - Country:US
Mailing Address - Phone:816-313-2800
Mailing Address - Fax:816-792-9819
Practice Address - Street 1:153 W 151ST ST
Practice Address - Street 2:140
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5348
Practice Address - Country:US
Practice Address - Phone:913-764-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1275237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist